Hydrothorax after Central Vein Catheterization for Right Internal Jugular Vein and Contralateral Reexpansion Pulmonary Edema after Right Chest Tube Insertion: A case report / 대한마취과학회지

Cannulation of a large central vein is the standard clinical method for mornitoring CVP and is also performed for a number of additional therapeutic interventions, such as providing secure vascular access for administration of vasoactive drugs or to initiate rapid fluid resuscitation in operation or for aspiration of air emboli. But there are many complications such as vessel injury, pneumothorax, nerve injury, arrhythmias, arteriovenus thrombus, pulmonary emboli, infection at insertion site, because there are major vessels, nerve and organs around of central veins. We report a case of Rt. Hydrothorax after internal jugular vein cannulation and a contralateral reexpansion pulmonary edema and pleural effusion after Rt. chest tube insertion for hydrothorax.

A Case Report of Spinal Anesthesia for a Patient with the Shy-Drager Syndrome: A case report / 대한마취과학회지

Shy-Drager syndrome (SDS) is a chronic progressive disease with central autonomic nervous system defect, Parkinsonism, and cerebellar defect. The clinical maifestations of this syndrome are orthostatic hypotension, urinary and bowel dysfunction, impaired sexual potency, impaired libido, decreased sweating, ataxia, dysarthria, intension tremor, and vocal cord palsy. Anesthesiologists should consider SDS as having major implications during surgery when choosing the anesthetic technique, monitoring, and postoperative care because it causes loss of autonomic regulation of vascular tone. We report a successful spinal anesthesia for left salphingo-oophorectomy in a female patient with Shy-Drager syndrome.

The Interaction of Morphine and Adenosine Receptor Agonists on Antiallodynia in Rats with a Nerve Ligation Injury / 대한마취과학회지

BACKGROUND: A Nerve ligation injury may produce a pain syndrome that includes tactile allodynia. Reversal effects on tactile allodynia have been demonstrated after an intrathecal administration of adenosine analogues or morphine. Adenosine receptor agonists have been known to have antinociceptive and antiallodynic effects in many animal and human studies. We examined the drug interactions between morphine and adenosine agonists in a rat model of a nerve ligation injury. METHODS: Male Sprague Dawley rats were prepared with a tight ligation of the left lumbar 5 th and 6 th spinal nerves and chronic lumbar intrathecal catheter implantation for drug administration. We measured the tactile allodynia by applying von Frey filaments ipsilateral to the lesioned hindpaw. Thresholds for paw withdrawal were assessed. Morphine (1 - 30ng), adenosine (1 - 30ng) and R-PIA (0.1 - 10ng) were administered to obtain the dose-response curves and the 50% effective dose (ED50). Fractions of ED50 values were administered to establish the ED50 of drug combinations. Drug interactions were evaluated by the fractional and isobolographic analyses. Allodynic thresholds for left lesioned hindpaw withdrawal to the von Frey hairs test were assessed and converted to % maximal possible effect (%MPE). RESULTS: The antiallodynic effect of morphine, adenosine, and R-PIA were produced in a dose dependent manner. The antiallodynic effects of combinations showed a similar pattern. Isobolographic analysis revealed a synergistic interaction for the morphine-R-PIA combination but not for the morphine-adenosine combination. However, fractional analysis produced a synergistic result for two combination groups. CONCLUSIONS: The results demonstrated that intrathecal co-administration of adenosine A1 receptors agonist and morphine showed the synergistic effect on nerve ligation injury induced allodynia.

The Efficacy of Electroencephalography and Somatosensory Evoked Potential Monitoring for Detecting Cerebral Ischemia during Carotid Endarterectomy under Regional Anesthesia / 대한마취과학회지

BACKGROUND: Carotid endarterectomy has been proven to be beneficial for the prevention of strokes in both symptomatic and asymptomatic patients with significant carotid stenosis. Even if there is no consensus as to the most appropriate monitoring method for detecting cerebral ischemia during carotid endarterectomy, electroencephalography (EEG) and/or somatosensory evoked potential (SSEP) has been extensively used to evaluate cerebral functions. We estimated the efficacy of EEG and SSEP for detecting cerebral ischemia during carotid endarterectomy in conscious patients. METHODS: One or both of 16-channel EEG and SSEP monitoring were performed in 103 patients scheduled for carotid endarterectomy under cervical plexus block. We estimated the sensitivity and specificity of EEG and SSEP for detecting cerebral ischemia expressed by altered consciousness and shunt insertion. RESULTS: During carotid clamp in 74 cases studied, significant EEG changes were noted in 5 of the 16 patients who had cerebral ischemia, however 11 patients had no EEG changes despite cerebral ischemia. During carotid clamp in 84 cases studied, significant SSEP changes were noted in 7 of the 19 patients who had cerebral ischemia, however 12 patients had no SSEP changes despite cerebral ischemia. The sensitivity and specificity for detecting cerebral ischemia were 31% and 86% for EEG and 37% and 95% for SSEP, respectively. CONCLUSIONS: We conclude that EEG and SSEP monitoring during carotid endarterectmy under regional anesthesia is not a sensitive method for detecting cerebral ischemia.